- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.04 / $889.97 / $3,458.25
| Professional | | $783.04 | $889.97 | $3,458.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.74 / $1,749.74 / $1,749.74
| Facility | | $1,749.74 | $1,749.74 | $1,749.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.61 / $1,172.50 / $2,198.36
| Professional | | $859.61 | $1,172.50 | $2,198.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,235.14 / $1,387.72 / $1,671.08
| Professional | | $1,235.14 | $1,387.72 | $1,671.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.28 / $1,125.59 / $1,313.20
| Professional | | $994.28 | $1,125.59 | $1,313.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.05 / $1,172.50 / $1,535.06
| Professional | | $845.05 | $1,172.50 | $1,535.06 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.18 / $3,692.19 / $9,324.00
| Professional | | $904.18 | $3,692.19 | $9,324.00 |